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U.S. Department of Health and Human Services

7.4 Procedural Guidance for Healthcare Coalition Written Agreements

Healthcare Coalition mutual aid instruments should also include guidance on how to acquire and manage resources during an emergency. This may include procedures for requesting, deploying, tracking, managing, demobilizing, and rehabilitating resources.

7.4.1 Resource Requests and Offers of Assistance

The following issues should be considered in developing procedural guidance for resource requests:

  • Resource descriptions: Resource typing is the methodology used in ICS to provide standardized descriptions of resources that may be shared. This helps to assure accuracy in meeting resource requirements. It is especially relevant to the medical profession, as there can be subtle yet important differences between similarly sounding requests. A Federal initiative is underway to address healthcare resource typing and credentialing, and a limited list of resource types currently exist for medical and public health teams.[7] Mutual aid instruments should delineate the process in which resources will be described to minimize inaccuracies, particularly for resources that are not described in the FEMA listing.
  • Format for resource requests: This should be kept simple and include the name, response position title, and contact information of the individual making the request, along with the name of the requesting organization. The request should specify a reporting location for deployed personnel, a brief description of duties, and the start time and anticipated length of service.
  • Authority to request or offer resources: This involves specifying who within a Healthcare Coalition member organization has the authority to request and offer resources.
  • Transmission of requests: This involves specifying how requests are transmitted to the HCRT for rapid dissemination to other Coalition members. Donor organizations can contact the requesting organization directly or any offers of assistance can be aggregated by the HCRT Operations Section and provided to the requesting organization.
  • Completing the resource sharing arrangement: The specific agreement for assistance is made directly between the requesting and the donating organizations, facilitated by the HCRT if desired by the involved parties. An agreement template for this purpose may be helpful.

7.4.2 Transportation of Resources

Transportation of resources should be considered when developing the mutual aid instrument. Stipulations should include how the resources will be delivered to the supported organization and returned to the assisting organization (as appropriate). A range of transportation options may be available, including the following:

  • Healthcare organizations may own adequate transportation assets that can be used during incident response (e.g., hospital based ambulance services).
  • Arrangements may be made during preparedness planning with public sector agencies, such as EMS, departments of transportation, or mass transit agencies to supply transportation assets for emergency assistance.
  • Similarly, private sector assets may exist within the community that could be engaged in contingency contracts or other written mutual aid instruments.

7.4.3 Transferring Patients

Procedures governing the day-to-day transfer of patients between healthcare organizations are typically well delineated, but can be time and labor intensive. Modifications may be needed to expedite this process during an emergency and should address the following:

  • Assigning receiving facilities: For routine patient transfer, it is usually the responsibility of the individual practitioner or healthcare organization to locate an appropriate and available receiving facility and care provider. During emergencies, this may be better coordinated through the HCRT by communicating requests for assistance to all participating organizations at one time. The HCRT Operations Section may then aggregate offers of assistance and connect the most appropriate to the requesting organization. This takes on critical importance in situations such as the emergency evacuation of a healthcare facility.
  • Transfer procedures and related details: Issues related to the transfer of patients should be addressed during preparedness and may include the following:
    • Who is responsible for arranging patient transport?
    • When does responsibility for the transferred patient transition from the sending organization to the patient receiving facility?
    • What patient records (including family contact information) will be included? Is remote access to electronic medical records an option?
    • What other minimum documentation is required to accompany patients being transferred?
    • How will patient transfer actually occur?
    • What authority does the patient receiving facility have to assign a new medical provider?
    • Will courtesy or temporary privileges be assigned to the patient’s regular treating physician?
    • What procedures will be used to confirm arrival and acceptance of transferred patients?
    • What equipment, supplies, or medication should be transferred with the patient?
    • How will payment for care at the new facility be processed and submitted to third party payers (see below)
  • Notification of transfer: This includes messages to the receiving facility that a patient is en route, confirmation by the receiving facility that the patient has arrived, responsibility for notification of patients’ families regarding the emergency transfer and points of contact at the receiving facility, and confirmation by the patient receiving facility to the patient’s family that the transfer has been completed.
  • Integration with other organizations: During large incidents, mechanisms such as the National Disaster Medical System (NDMS) and its associated Federal Coordinating Centers (FCC) may become active. Coalitions should consider including regional representatives from NDMS and the regional FCC in discussions of these issues during Coalition preparedness.

7.4.4 Physician Admitting Privileges

After emergency evacuation of a healthcare facility, it may be appropriate to grant courtesy privileges at receiving facilities so that the personal physician of a transferred patient can provide continuity of care in the receiving facility. The methodology to address this could be similar to granting emergency privileges. This may need to be addressed through medical staff by-laws and other administrative avenues.

7.4.5 Healthcare Third Party Payment Coverage

Payment for healthcare services rendered in the care of patients who are transferred in an emergency may be another consideration to address in the Coalition’s mutual aid instrument. Resolution of issues may require discussion with major regional insurers, relevant government health insurance, and consumer advocacy agencies to address:

  • Payment for services when the patient(s) is transferred to a facility that is not “approved” by the involved insurer.
  • Insurance policies that do not recognize an emergency transfer as a “new” hospitalization for the patient.
  • Timely payments to healthcare providers not typically within the provider coverage of the third party payer.
  • During a large-scale or complex incident, certain government authorized waivers may be enacted.[8] The HCRT should work closely with its government representatives to understand these implications before any emergency. Coalitions should also be prepared for incidents that do not meet this level of governmental action/declaration.

During a large-scale incident, certain government authorized waivers may take precedent. The HCRT should work closely with its government partners to understand these implications prior to any emergency.

7.4.6 Rehabilitating Resources and Costs

When establishing resource-sharing procedures, it is important to consider at least general guidance for rehabilitation and return of the shared assets. Issues for the Coalition to consider include:

  • Responsibility for arranging and paying for return transportation
  • Timeframe in which reimbursement to the donor organizations should occur
  • Special vendors for servicing durable equipment
  • Re-order information for non-durable goods
  • Procedures related to employee health for evaluating and “rehabbing” deployed personnel or providing long-term tracking and follow-up of deployed personnel potentially exposed to a health hazard
  • Recertification procedures before facilities that have been used for a special purpose can return to their normal function.

Finally, a dispute resolution method should be established to address difficult issues that could arise between donor and requesting organizations during emergency response and recovery.



  1. FEMA. Resource Management: Resource Typing; Available at: http://www.fema.gov/emergency/nims/ResourceMngmnt.shtm#item4.
  2. U.S. Department of Health and Human Services, Legal Authority for Implementation of a Federal Public Health and Medical Services Response; Available at: http://www.phe.gov/preparedness/support/secauthority/Pages/default.aspx.

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  • This page last reviewed: May 14, 2013